Palpitations can predict future atrial fibrillation

TROMSOE, NORWAY. A team of researchers from the University of Tromsoe reports the results of an 11-year study aimed at determining major risk factors for the development of atrial fibrillation (AF). The 22,815 participants, for whom the necessary data was available, were part of the Tromsoe Study started in 1974 to determine risk factors for, and incidence of, cardiovascular disease in the municipality of Tromsoe. During the period 1994 to 1995 the all the participants (aged 25 to 96 years) underwent a thorough medical examination and answered a comprehensive questionnaire. One of the questions asked was, have you noticed sudden changes in your heart rate or heart rhythm in the past year? During the mean follow-up of 11.1 years, 361 women (3.0%) and 461 men (4.2%) were diagnosed with AF documented on an electrocardiogram. This corresponds to an incidence rate of 0.27%.year in women and 0.39%/year in men. At the end of the follow-up, further examinations were made to determine if the participants had developed, or still had, coronary artery disease, congestive heart failure, valvular heart disease, and enlarged atria. Participants with AF who were free from heart disease, hypertension and diabetes, and who were under the age of 65 years at the time of AF diagnosis were considered to have lone atrial fibrillation (LAF). Only 49 participants met this rather strict definition, indicating that 6% of the entire AF population of 361 had LAF. Considering the entire study population, only 0.21% developed LAF during the 11-year follow-up.

The main risk factors for developing AF are listed below (percent relative risk increase associated with the indicated risk factor when compared to the group without AF):

Risk Factor
Women
Men
Age
434%
406%
Height
NS*
33%
BMI
16%
47%
Total cholesterol[1]
NS*
- 11%
HDL cholesterol[1]
12%
16%
Hypertension[2]
98%
40%
Palpitations
62%
91%
Diabetes
61%
NS*%
Coronary heart disease
43%
61%

*statistically non-significant
[1] Per one standard deviation increase from average
[2] Hypertension was defined as blood pressure above 140/90, or the use of antihypertensive drugs

The main risk factors for women were thus, advancing age, hypertension, palpitations, diabetes, and coronary artery disease, while for men they were, advancing age, palpitations, coronary artery disease, elevated BMI (body mass index) and hypertension. In the case of LAF, the main risk factors were as follows:

Risk Factor
Women
Men
Age
232%
190%
Height
NS*
249%
BMI
NS*
213%
Systolic blood pressure
- 72%
- 79%
Palpitations
274%
NS*

Higher systolic blood pressure was associated with a reduced risk of LAF. The researchers have no explanation for this. They noted no association between the development of AF and smoking, low physical activity, coffee consumption, or the use of alcohol. They conclude that age, palpitations, hypertension, coronary artery disease, and elevated BMI are risk factors for AF in both men and women. Apart from aging, elevated body height and BMI were the main risk factors for LAF in men, while palpitations were the main LAF risk factor for women.
Nyrnes, A, et al. Palpitations are predictive of future atrial fibrillation. European Journal of Preventive Cardiology, April 5, 2012 [Epub ahead of print]

Editor’s comment: It is interesting that the strong association between height and risk of LAF was initially reported by Patrick Chambers, MD in his article “Lone Atrial Fibrillation: Pathologic or not?” published in 2007 in Medical Hypotheses. Dr. Chamber’s article was based on the results of our LAF Survey 11 undertaken in 2007.